This is an application for a K08 Mentored Clinical Scientist Development Award for Dr. Neda Ratanawongsa, an Assistant Adjunct Professor in General Internal Medicine at the University of California, San Francisco, who is establishing herself as a young investigator in health informatics implementation research. This K08 award with provide her with the necessary support to tailor an objective measure of medication adherence for use in a safety net health care system and integrate this measure into a safety net electronic health record system to promote more patient-centered treatment decision-making. To achieve these goals, Dr. Ratanawongsa has assembled a multi-disciplinary mentoring team comprised of a primary mentor, Dr. Dean Schillinger, a renowned expert in health communication and safety net practice-based research using health information technology interventions, and three co-mentors: Dr. Andrew Karter, an health services researcher and expert in medication adherence; Dr. Julie Schmittdiel, Director for the Health Delivery Systems Center for Diabetes Translational Research and health care organizations expert in practice-based intervention research; and Dr. Glyn Elwyn, an internationally renowned expert in practice-based informatics interventions to improve shared decision-making. Public health safety net systems serve high proportions of low-income and racial/ethnic minorities with high diabetes prevalence and poor clinical outcomes. Safety net ambulatory clinics are undergoing a transformation with Medicaid expansion and widespread implementation of electronic health record systems triggered by national legislation. Dr. Ratanawongsa will leverage this unique context and data from an AHRQ R18-funded trial of diabetes self-management support implemented by a Medicaid managed care plan. Specifically, she will develop an objective and practical system to detect inadequate medication adherence in a diverse population of Medicaid managed care plan members with diabetes (Aim 1) and elucidate key communication strategies and factors that facilitate higher quality shared decision-making and improved adherence in safety net encounters for Medicaid managed care plan members (Aim 2). She will then engage patients and clinicians to develop a comprehensive multimodal intervention to provide medication refill adherence data through a safety net electronic health record decision support tool (Aim 3). Through a focused program of mentored training and coursework, the candidate will develop advanced skills in medical informatics, conversational analysis, and practice-based implementation research in safety net settings. At the completion of this award, Dr. Ratanawongsa will be well positioned to develop an R01 application to test the effectiveness of a multimodal electronic health record intervention to improve patient medication adherence, shared decision-making, and patient-important outcomes for safety net populations with chronic diseases.